微信預(yù)約
微信訂閱號(hào)
微信預(yù)約微信訂閱號(hào)
微信預(yù)約微信訂閱號(hào)General Hospital
0377-63876387
您所在的位置： 首頁 >>新聞動(dòng)態(tài) >>行業(yè)新聞
黨的十六大以來，我國(guó)衛(wèi)生工作取得積極進(jìn)展，覆蓋城鄉(xiāng)的醫(yī)療衛(wèi)生服務(wù)體系基本形成，疾病防治能力不斷增強(qiáng)，醫(yī)療保障覆蓋人口逐步擴(kuò)大，基本藥物制度初步建立，衛(wèi)生事業(yè)得到全面發(fā)展，人民群眾健康水平顯著提高。人均期望壽命從2000年的71.4歲提高到2010年的74.8歲。孕產(chǎn)婦死亡率逐年下降，從2002年的51.3/10萬下降到2011年的26.1/10萬。嬰兒死亡率及5歲以下兒童死亡率持續(xù)下降，嬰兒死亡率從2002年的29.2‰下降到2011年的12.1‰，5歲以下兒童死亡率從2002年的34.9‰下降到2011年的15.6‰，提前實(shí)現(xiàn)聯(lián)合國(guó)千年發(fā)展目標(biāo)，我國(guó)居民的健康水平已處于發(fā)展中國(guó)家前列。
一、衛(wèi)生事業(yè)加快發(fā)展，深化醫(yī)藥衛(wèi)生體制改革取得重大進(jìn)展
2002年以來，經(jīng)過抗擊非典疫情的嚴(yán)峻考驗(yàn)，黨中央提出了“以人為本”的科學(xué)發(fā)展觀，將發(fā)展衛(wèi)生事業(yè)放在了更加突出的位置，增加政府投入，加強(qiáng)公共衛(wèi)生服務(wù)體系、基層醫(yī)療衛(wèi)生服務(wù)體系和基本醫(yī)療保障制度建設(shè)。黨的十七大確定了人人享有基本醫(yī)療衛(wèi)生服務(wù)的奮斗目標(biāo)，指明了堅(jiān)持公共醫(yī)療衛(wèi)生公益性質(zhì)的根本方向，明確了建立基本醫(yī)療衛(wèi)生制度的歷史任務(wù)。2009年3月，中共中央、國(guó)務(wù)院做出了進(jìn)一步深化醫(yī)藥衛(wèi)生體制改革的重大決策，確定了2009--2020年衛(wèi)生改革的制度框架、政策思路和目標(biāo)任務(wù)，經(jīng)過三年多的努力，五項(xiàng)重點(diǎn)改革統(tǒng)籌推進(jìn)，取得了重大階段性成效。
（一）基本醫(yī)療保障制度基本建立。2011年，城鄉(xiāng)居民參加職工醫(yī)保、城鎮(zhèn)居民醫(yī)保、新農(nóng)合人數(shù)超過13億，覆蓋率達(dá)到95%以上，我國(guó)建立起世界上最大的醫(yī)療保障網(wǎng)。2003年起開展新型農(nóng)村合作醫(yī)療制度試點(diǎn)并逐步在全國(guó)推廣，覆蓋面迅速擴(kuò)大，全國(guó)參合人口從2003年的0.8億增至2011年的8.32億。新農(nóng)合籌資力度逐年加大，醫(yī)療保障水平大幅提升。新農(nóng)合人均籌資水平從2003年的30元提高到2011年的246元，受益人次數(shù)從2004年的0.76億人次提高到2011年的13.15億人次，政策范圍內(nèi)住院費(fèi)用報(bào)銷比例達(dá)到70%以上。新農(nóng)合重大疾病保障機(jī)制初步建立，2012年上半年已有超過34萬人次獲得補(bǔ)償。2003年和2005年分別建立了農(nóng)村和城市醫(yī)療救助制度，2011年全國(guó)城鄉(xiāng)醫(yī)療救助總?cè)舜芜_(dá)8887萬，救助資金支出186.6億元。
（二）基本藥物制度從無到有建立起來。政府辦基層醫(yī)療衛(wèi)生機(jī)構(gòu)全部配備使用基本藥物并實(shí)施零差率銷售。目前，正向村衛(wèi)生室和非政府辦基層醫(yī)療衛(wèi)生機(jī)構(gòu)延伸?；鶎踊舅幬飪r(jià)格比改革前平均下降30%。人事、分配、補(bǔ)償和績(jī)效考核等方面的基層醫(yī)療衛(wèi)生機(jī)構(gòu)運(yùn)行新機(jī)制逐步建立。據(jù)調(diào)查，改革后財(cái)政和醫(yī)保對(duì)基層醫(yī)療衛(wèi)生機(jī)構(gòu)收入的補(bǔ)償比例達(dá)到72%，比改革前提高了22個(gè)百分點(diǎn)。
（三）基層醫(yī)療衛(wèi)生服務(wù)體系建設(shè)顯著加強(qiáng)。覆蓋城鄉(xiāng)的基層醫(yī)療衛(wèi)生服務(wù)網(wǎng)絡(luò)基本建成，基層醫(yī)療衛(wèi)生機(jī)構(gòu)軟硬件都得到很大改善，基層服務(wù)網(wǎng)底功能逐步顯現(xiàn)。醫(yī)改三年來，基層醫(yī)療衛(wèi)生機(jī)構(gòu)的診療人次比改革前增加8.43億，增長(zhǎng)了28.5%。“小病在基層，大病去醫(yī)院”的就醫(yī)新秩序正在形成。
（四）基本公共衛(wèi)生服務(wù)逐步均等化水平明顯提高。國(guó)家免費(fèi)向全體城鄉(xiāng)居民提供10類41項(xiàng)基本公共衛(wèi)生服務(wù)項(xiàng)目。針對(duì)特殊疾病、重點(diǎn)人群和特殊地區(qū)，國(guó)家實(shí)施重大公共衛(wèi)生服務(wù)項(xiàng)目，惠及近2億群眾。國(guó)家支持8000多個(gè)公共衛(wèi)生服務(wù)機(jī)構(gòu)建設(shè)，公共衛(wèi)生服務(wù)能力有效提升。
（五）公立醫(yī)院改革試點(diǎn)有序推進(jìn)。在17個(gè)國(guó)家試點(diǎn)城市、37個(gè)省級(jí)試點(diǎn)城市、超過2000家醫(yī)院推進(jìn)公立醫(yī)院體制機(jī)制改革試點(diǎn)。探索建立現(xiàn)代醫(yī)院管理制度，推進(jìn)大衛(wèi)生體制下的管辦分開。北京、深圳等試點(diǎn)城市近期公立醫(yī)院改革在取消藥品加成、建立全新補(bǔ)償、運(yùn)行、監(jiān)管機(jī)制上取得突破性進(jìn)展和初步成效。全面推進(jìn)預(yù)約掛號(hào)、雙休日和節(jié)假日門診、優(yōu)質(zhì)護(hù)理服務(wù)等便民惠民措施。開展臨床路徑管理，推行同級(jí)醫(yī)療機(jī)構(gòu)檢查檢驗(yàn)結(jié)果互認(rèn)，有效控制醫(yī)藥費(fèi)用。以取消以藥補(bǔ)醫(yī)機(jī)制為關(guān)鍵環(huán)節(jié)，啟動(dòng)縣級(jí)公立醫(yī)院綜合改革，統(tǒng)籌推進(jìn)人事、分配、補(bǔ)償、績(jī)效考核等方面的改革，注重提升服務(wù)能力，構(gòu)建基層首診、雙向轉(zhuǎn)診、上下聯(lián)動(dòng)、分工協(xié)作的就診新格局。
二、衛(wèi)生資源持續(xù)增長(zhǎng)，基本醫(yī)療衛(wèi)生服務(wù)公平性、可及性顯著提高
（一）衛(wèi)生總費(fèi)用增加、籌資結(jié)構(gòu)不斷優(yōu)化。據(jù)初步核算，2011年，全國(guó)衛(wèi)生總費(fèi)用達(dá)24269億元，衛(wèi)生總費(fèi)用占GDP比重預(yù)計(jì)達(dá)5.1%。2002年以來，人均衛(wèi)生總費(fèi)用每年平均增長(zhǎng)10.8%（按可比價(jià)格計(jì)算，下同）。2002年，我國(guó)衛(wèi)生總費(fèi)用中個(gè)人衛(wèi)生支出比重高達(dá)57.7%，政府預(yù)算衛(wèi)生支出和社會(huì)衛(wèi)生支出分別僅占15.7%和26.6%。2011年個(gè)人衛(wèi)生支出的比重下降到34.9%，政府預(yù)算和社會(huì)衛(wèi)生支出的比重分別提高到30.4%和34.7%。這一結(jié)構(gòu)性變化說明我國(guó)衛(wèi)生籌資結(jié)構(gòu)趨向合理，居民負(fù)擔(dān)相對(duì)減輕，籌資公平性有所改善。
（二）衛(wèi)生資源持續(xù)增長(zhǎng)。2011年底，全國(guó)醫(yī)療衛(wèi)生機(jī)構(gòu)達(dá)95.4萬個(gè)，其中：醫(yī)院2.2萬個(gè)、基層醫(yī)療衛(wèi)生機(jī)構(gòu)91.8萬個(gè)。與2003年比較，醫(yī)療衛(wèi)生機(jī)構(gòu)增加14.8萬個(gè)。每千人口執(zhí)業(yè)(助理)醫(yī)師數(shù)由2002年1.47人增加到2011年1.82人，每千人口注冊(cè)護(hù)士數(shù)由2002年1.00人增加到1.66人。每千人口醫(yī)療衛(wèi)生機(jī)構(gòu)床位數(shù)由2002年的2.48張?zhí)岣叩?011年的3.81張。
（三）衛(wèi)生服務(wù)利用狀況顯著改善。全國(guó)醫(yī)療機(jī)構(gòu)門診量由2002年的21.45億人次增加到2011年的62.7億人次；住院人數(shù)由2002年的5991萬人增加到2011年的1.5億人。居民看病就醫(yī)更加方便，可及性顯著提高，15分鐘內(nèi)可到達(dá)醫(yī)療機(jī)構(gòu)住戶比例從2003年的80.7%提高到2011年的83.3%。
（四）醫(yī)藥費(fèi)用控制初見成效。2011年社區(qū)衛(wèi)生服務(wù)中心次均門診費(fèi)用和人均住院費(fèi)用比2008年分別下降13.5%和14.8%（可比價(jià)格計(jì)算，下同）。鄉(xiāng)鎮(zhèn)衛(wèi)生院醫(yī)藥費(fèi)用增長(zhǎng)幅度下降。2011年公立醫(yī)院次均門診費(fèi)用和住院費(fèi)用均上漲2.2%，與前兩年病人費(fèi)用持續(xù)上漲6%以上相比，漲幅明顯下降，公立醫(yī)院費(fèi)用控制初見成效。
（五）城鄉(xiāng)間衛(wèi)生發(fā)展差距逐步縮小。2003年我國(guó)城鄉(xiāng)居民享有基本醫(yī)療保障的比例分別為55%和21%，城鎮(zhèn)顯著高于農(nóng)村，2011年這一比例分別增至89%和97%，農(nóng)村反超城鎮(zhèn)。城鄉(xiāng)居民健康指標(biāo)差距也在縮小，孕產(chǎn)婦死亡率城鄉(xiāng)之比由2002年的1：2.61縮小為2011年的1：1.05；嬰兒死亡率城鄉(xiāng)差距也從2002年的20.9個(gè)千分點(diǎn)下降到2011年8.9個(gè)千分點(diǎn)。
黨的十六大以來是我國(guó)衛(wèi)生事業(yè)改革發(fā)展更好、更快的時(shí)期，我們將再接再厲，攻堅(jiān)克難，開拓進(jìn)取，完成“十二五”時(shí)期衛(wèi)生改革發(fā)展的各項(xiàng)任務(wù)，早日實(shí)現(xiàn)人人享有基本醫(yī)療衛(wèi)生服務(wù)的目標(biāo)。
Material for the press conference of the State Council Information Office I
The Reform and Development of China’s Health Sector
Since the 16th CPC National Congress
Since the 16th CPC National Congress, China’s health sector has experienced tremendous progress, including the primary formation of a health service delivery system in both urban and rural areas, enhanced capacity of diseases prevention and control, expanded coverage of health insurances, and the preliminary establishment of the Essential Drug System, all of which led to the comprehensive development of the health sector and significant improvement in the health status of the population. The average life expectancy rose from 71.4 in 2000 to 74.8 in 2010. The maternal mortality rate dropped from 51.3/100,000 in 2002 to 2.61/100,000 in 2011. The infant mortality rate decreased from 29.2‰ in 2002 to 12.1‰ in 2011, and the mortality rate of children under five fell from 34.9‰ in 2002 to 15.6‰ in 2011. The above figures demonstrate that China has successfully achieved the Millennium Development Goals ahead of schedule and becomes one of the leading developing countries in terms of the health status of the population.
1. The development of health sector is accelerating and healthcare reform has made significant progress.
After 2002, having gone through the battle against SARS, the CPC Central Committee put forward the Scientific Outlook on Development with people-centered views and gave higher priority to the development of health sector. The government increased investment in the enhancement of the public health service system, the grass-roots level health service delivery system and the basic medical insurance system.Then, the 17th CPC National Congress determined the goal of ensuring basic health services for all, defined the direction of providing public welfare in the health sector, and identified the historical task of building the essential health system. In March 2009, the Central Committee and the State Council made the decision to further strengthen the healthcare reform and determined its framework, policy and goals. After three years of hard work, we have made initial achievements in the following five aspects.
1) The basic health insurance system has been preliminarily established.In 2011, the population covered by employee insurance, resident insurance and the New Rural Cooperative Medical Scheme (NRCMS) reached 1.3 billion, over 95% of the total population, which made it the largest medical insurance network in the world.The NRCMS coverage has been expanding across the country since 2003 when the pilot was launched, with its insured population rising from 80 million in 2003 to 832 million in 2011.The fund pooled per capita for NRCMS increased from 30 yuan in 2003 to 246 yuan in 2011, benefiting 1.315 billion people in 2011, up from 76 million in 2004, with 70% in-patient expenses reimbursable within the policy. During the first 6 months, 2012 the NRCMS catastrophic disease insurance mechanism has been preliminarily established and more than 340,000 person times has been reimbursed. A medical relief system for rural and urban areas has been established in 2003 and 2005 respectively. By 2011, it has provided financial support of 18.66 billion yuan to 88.87 million person times.
2) The Essential Drug System has been established from scratch. Essential drugs without zero markup are offered in government-run grass-roots health institutions. Currently this practice is expanding to village clinics and other non-government-run grass-roots health institutions. In grass-roots level, the price of essential drugs has reduced by 30%. A new operation mechanism in grass-roots health institutions has formed in terms of personnel administration, drug distribution, government funding, and performance evaluation. Our investigation shows that after the healthcare reform, the proportion of government funding and medical insurance in the total revenue of a grass-roots health institution has reached 72%, up 22% before the reform.
3) The grass-roots health service delivery system has been significantly strengthened. A grass-roots health service network covering both urban and rural areas has been preliminarily established, with better facilities and personnel. After the three years of reform, visits to grass-roots health institutions have increased by 28.5%- 843 million. Treating minor diseases at grass-roots level and major diseases in hospitals has become a new philosophy among patients.
4) Equal access to public health services has evidently enhanced. The government provides 41 items of basic public health services in ten categories free-of-charge. Mega public health service programs promoted by the government targeting specific diseases, high-risk population and specific areas benefited 200 million people. And the building of more than 8000 public health service institutions is supported by the government, indicating an improvement of service capacity.
5) Public hospital pilot reform has been making steady progress. Pilot reform has been carried out in more than 2000 hospitals of 17 national level pilot cities and 37 provincial level pilot cities. Modern hospital administrative systems are tentatively established, which means the separation of administration and operation under the larger health system. In pilot cities such as Beijing and Shenzhen, recent public hospital reform has made some breakthrough and achieved preliminary progress in canceling drug markup, and establishing a brand new funding, operating and monitoring mechanism. Online registration, non-workday clinic service, and quality nursing are offered to residents of those cities. To effectively control medical expenses, clinical pathway is promoted, and recognition of medical examination and lab test results among hospitals at the same level is promoted. In order to eliminate subsidizing medical services with drug sales, we started to press ahead a comprehensive reform on county level public hospitals by reforming their personnel management, drug distribution, funding and performance evaluation, with a focus on enhancing service capacity, and establishing a new pattern featuring first diagnoses on grass-roots level, mutual referral between hospitals, cross-level hospital cooperation and division of labor.
2. Health resources continue to grow, and equity of and access to basic medical services have been significantly improved.
1) Total health expenditure (THE) is increasing and financing structure is optimizing. In 2011, the estimated THE reached 2426.9 billion yuan, 5.1% of GDP. Since 2002, THE per capita grows by 10.8% annually (calculate at comparable price, so are the following numbers). In 2002, out-of-pocket expenditure accounted for 57.7% of THE, while the government and social expenditure accounted for 15.7% and 26.6% of THE respectively. In 2011, percentage of out-of-pocket expenditure fell to 34.9%, while the proportion of government and social expenditure increased to 30.4% and 34.7%. This structural change indicates a more rational financing structure, a lighter burden for the residents and an improvement in the equality of funding.
2) The health resources continue to grow. By the end of 2011, there were 954,000 health institutions, including 22,000 hospitals and 918,000 grass-roots health institutions. There was an increase of 148,000 institutions compared with the figure of 2003. The number of registered (associated) doctors per thousand population increased from 1.47 in 2002 to 1.82 in 2011, registered nurses up from 1.00 in 2002 to 1.66 in 2011, and hospital beds up from 2.48 in 2002 to 3.81 in 2011.
3) The utilization of health services has grown significantly. The total outpatients number was up from 2.145 billion person times in 2002 to 6.27 billion in 2011, and the total inpatients number up from 59.91 million in 2002 to 1500 million in 2011. With more convenient access to health care services, the number of residents within 15 minutes walking distance radius has risen from 80.7% in 2003 to 83.3% in 2011.
4) Medical expense has been more effectively controlled. In 2011, the expenses for each outpatient visit and inpatient per capita in community health service centers have fallen by 13.5% and 14.8% from 2008 respectively (calculate at comparable price, so are the following numbers). The medical expenses in township hospitals are rising more slowly. In 2011, the expenses for each outpatient visit and inpatient per capita in public hospitals both rise by 2.2%, a significant smaller number comparing to 6% rise in the previous two years, indicating a better controlled public hospital expense.
5) The gap between urban and rural areas in health development is bridging. In 2003, 55% of urban residents were covered by a basic health insurance, while the rate for rural residents was only 22%. In 2011, the rates for urban and rural residents with insurance became 89% and 97%, with a larger percentage of rural population than urban population covered by medical insurance. The gap of health status between urban and rural areas is also closing, with maternal mortality rate gap falling from 1:2.61 in 2002 to 1:1.05 in 2011, and infant mortality rate gap falling from 20.9‰ in 2002 to 8.9‰ in 2011.
The decade after the 16th CPC National Congress has seen a rapid progress in our health sector. We would continue to make efforts to overcome difficulties, fulfill the tasks set by the 12th Five Year Plan, and achieve the goal of providing basic health services to all.
中國(guó)的新型農(nóng)村合作醫(yī)療制度發(fā)展
國(guó)務(wù)院新聞辦公室新聞發(fā)布會(huì)材料二
2012年是新農(nóng)合制度實(shí)施十周年。十年來，在各級(jí)黨委、政府的高度重視和正確領(lǐng)導(dǎo)下，有關(guān)部門通力合作，農(nóng)民群眾積極參與，新農(nóng)合制度建設(shè)扎實(shí)推進(jìn)，取得了顯著成效。
一是實(shí)現(xiàn)全面覆蓋，參合率穩(wěn)定在較高水平。新農(nóng)合制度自2003年開始試點(diǎn)，到2008年實(shí)現(xiàn)了全面覆蓋，參合人口數(shù)從試點(diǎn)初期的0.8億，逐年穩(wěn)步增長(zhǎng)，截至2012年6月底，參合人口達(dá)到8.12億人，參合率達(dá)到95%以上。
二是籌資水平不斷提高，保障能力逐步增強(qiáng)。新農(nóng)合人均籌資水平由2003年的30元提高到2011年的250元。2011年，有13.15億人次從新農(nóng)合受益，次均住院補(bǔ)償額為1894元。2012年，新農(nóng)合政策范圍內(nèi)住院費(fèi)用報(bào)銷比例進(jìn)一步提高到75%左右，最高支付限額提高到全國(guó)農(nóng)民人均純收入的8倍以上，且不低于6萬。
三是確立了較為完善的符合中國(guó)國(guó)情的制度框架和運(yùn)行機(jī)制。新農(nóng)合建立了由政府領(lǐng)導(dǎo)，衛(wèi)生部門主管，相關(guān)部門配合，經(jīng)辦機(jī)構(gòu)運(yùn)作，醫(yī)療機(jī)構(gòu)服務(wù)，農(nóng)民群眾參與、費(fèi)用補(bǔ)償公開的管理運(yùn)行機(jī)制；明確了以家庭為單位自愿參加，個(gè)人繳費(fèi)、集體扶持和政府資助相結(jié)合的籌資機(jī)制；形成了以住院大額費(fèi)用補(bǔ)償為主，并逐步向門診統(tǒng)籌擴(kuò)展的統(tǒng)籌補(bǔ)償模式，2011年在90%以上的地區(qū)開展了門診統(tǒng)籌，參合農(nóng)民受益范圍更加廣泛；建立了參合農(nóng)民在統(tǒng)籌區(qū)域內(nèi)自主就醫(yī)、即時(shí)結(jié)報(bào)的補(bǔ)償辦法，2011年，已有超過2/3的?。▍^(qū)、市）實(shí)現(xiàn)新農(nóng)合省市級(jí)定點(diǎn)醫(yī)療機(jī)構(gòu)即時(shí)結(jié)報(bào)；建立了基金封閉運(yùn)行機(jī)制和多方參與的監(jiān)管機(jī)制；深入推進(jìn)支付方式改革，2011年已有超過80%的地區(qū)開展了不同形式的支付方式改革，新農(nóng)合制度合理有效控制醫(yī)藥費(fèi)用的作用開始顯現(xiàn)；積極推進(jìn)商業(yè)保險(xiǎn)機(jī)構(gòu)參與經(jīng)辦新農(nóng)合服務(wù)工作，探索“管辦分開、政事分開”的新農(nóng)合管理運(yùn)行機(jī)制。
今后一個(gè)階段，結(jié)合中央深化醫(yī)改的總體部署，我們將重點(diǎn)推進(jìn)以下幾方面的工作：
一是穩(wěn)步提高新農(nóng)合籌資標(biāo)準(zhǔn)，2012年新農(nóng)合人均籌資水平將達(dá)到300元左右，到2015年，新農(nóng)合政府補(bǔ)助標(biāo)準(zhǔn)將提高到每人每年360元以上，個(gè)人繳費(fèi)標(biāo)準(zhǔn)適當(dāng)提高，并逐步探索建立與經(jīng)濟(jì)發(fā)展水平相適應(yīng)的籌資機(jī)制。
二是加強(qiáng)新農(nóng)合精細(xì)化管理，嚴(yán)格基金使用管理，加強(qiáng)對(duì)定點(diǎn)醫(yī)療機(jī)構(gòu)的監(jiān)管；全面推行新農(nóng)合省市級(jí)定點(diǎn)醫(yī)療機(jī)構(gòu)和村衛(wèi)生室的即時(shí)結(jié)報(bào)工作，逐步推行省外異地結(jié)報(bào)；加快新農(nóng)合信息化建設(shè)，結(jié)合居民健康卡的發(fā)放，快速推進(jìn)“一卡通”試點(diǎn)工作；加強(qiáng)新農(nóng)合與醫(yī)療救助等相關(guān)信息系統(tǒng)的互聯(lián)互通，推行“一站式”即時(shí)結(jié)算服務(wù)。
三是推進(jìn)提高重大疾病醫(yī)療保障水平試點(diǎn)工作，將兒童白血病、肺癌等20種疾病納入保障范圍。貫徹落實(shí)六部委《關(guān)于開展城鄉(xiāng)居民大病保險(xiǎn)工作的指導(dǎo)意見》，做好大病保險(xiǎn)與新農(nóng)合大病保障工作的銜接，優(yōu)先將這20種重大疾病納入大病保險(xiǎn)范圍。
四是加快推進(jìn)新農(nóng)合支付方式改革，用總額預(yù)付、按病種、按單元、按人頭等支付方式替代按項(xiàng)目付費(fèi)，控制費(fèi)用，規(guī)范醫(yī)療服務(wù)行為，提高基金績(jī)效。
五是加快推進(jìn)委托有資質(zhì)的商業(yè)保險(xiǎn)機(jī)構(gòu)參與新農(nóng)合經(jīng)辦服務(wù)工作，擴(kuò)大商業(yè)保險(xiǎn)機(jī)構(gòu)經(jīng)辦新農(nóng)合的規(guī)模，建立新農(nóng)合管理、經(jīng)辦、監(jiān)管相對(duì)分離的管理運(yùn)行機(jī)制。
六是認(rèn)真總結(jié)新農(nóng)合制度實(shí)施10年來的經(jīng)驗(yàn)，推動(dòng)《新農(nóng)合管理?xiàng)l例》及早出臺(tái)，盡快將新農(nóng)合納入法制化管理軌道。
實(shí)踐證明，新農(nóng)合制度符合農(nóng)村實(shí)際，是現(xiàn)階段農(nóng)村居民基本醫(yī)療保障制度的重要實(shí)現(xiàn)形式。十年來，新農(nóng)合制度從無到有，由小到大，對(duì)保障農(nóng)民健康發(fā)揮了重要作用。作為新農(nóng)合制度的主管部門，衛(wèi)生部門將會(huì)同有關(guān)部門繼續(xù)扎實(shí)推動(dòng)新農(nóng)合制度發(fā)展，促進(jìn)農(nóng)村居民健康水平穩(wěn)步提高。
Material for the press conference of the State Council Information Office II
The Development of
China's New Rural Cooperative Medical Scheme
2012 marks the tenth anniversary of the implementation of the New Rural Cooperative Medical Scheme (NRCMS). Over the past decade, with Party Committees and governments at all levels attaching great importance to NRCMS and under their strong leadership, relevant departments have given full cooperation and farmers have actively participated in the scheme. Therefore, NRCMS has made solid progress and remarkable achievements.
First, NRCMS has almost realized universal coverage with the participation remaining stable at a high level. Since the pilot programs in 2003, NRCMS achieved a comprehensive coverage in 2008. The participation number has grown steadily every year, from 80 million in the early stage of the pilot programs to 812 million by the end of June 2012, with over 95% of the targeted population covered.
Second, the financing continues to grow and the protection level improves gradually. The per capita cost of the insurance package increased from 30 yuan in 2003 to 250 yuan in 2011. In 2011, 1.315 billion person-times benefited from NRCMS with average hospitalization compensation amounting to 1,894 yuan. In 2012, the reimbursement for hospitalization costs will reach around 75%, with an annual payment ceiling of no less than 8 times of farmer’s per capita net income (no less than 60,000 yuan).
Third, a comprehensive institutional framework and operational mechanism is established in line with China's national conditions, i.e. led by the government; in the charge of health departments; supported by relevant sectors; operated by the insurance agencies; with services provided by the health institutions; participated by farmers and transparent reimbursement of the medial costs. NRCMS is co-financed by individual contributions, farmers’ cooperatives and both central and local governments, with families participating on a voluntary basis. The coordinated compensation focuses on reimbursement for hospitalization costs and gradually expands to out-patient care. In 2011, over 90% of areas carried out out-patient compensation which benefited the farmers in a wider range. The insured farmers can choose independently the designated hospitals for treatment and get real-time reimbursement. In 2011, over 2/3 of provinces (autonomous regions or municipalities) adopted real-time reimbursement in their designated provincial and municipal hospitals. The funds are operated in closed-end mechanism and supervised by multi-sectors. In 2011, over 80% of areas carried out various payment reforms, which supported NRCMS to effectively control the medical costs. Commercial insurance agencies are encouraged to involve in the operation of NRCMS, which explores the operational mechanism of “separating supervision from operation, and separating government administration from medical institutions”.
In the next stage, integrating with the overall arrangements for deepening the reform by the central government, we will press ahead in the following aspects:
First, the financing for NRCMS should grow in a steady pace. The fund pooled per capita will reach 300 yuan by 2012. By 2015, government subsidies will reach 360 yuan per person per year. The individual contribution will grow as appropriate. A financing mechanism that suits the economic development in China will be gradually established.
Second, the NRCMS should be meticulously managed, including strict utilization of the funds and enhancing supervision on designated hospitals. Real-time reimbursement should be established in designated provincial and municipal hospitals as well as village clinics across the country. Reimbursement for medical costs outside of one’s registered province should be gradually realized. The information engineering of NRCMS should be accelerated, in combination with distributing the health cards for the residents, in order to press ahead the all-in-one-card pilot program. The information systems of NRCMS and related schemes such as the medical assistance scheme should be better synchronized, to provide one-stop real-time compensation service.
Third, the pilot program of compensation for major diseases should be promoted, including 20 diseases such as child leukemia, lung cancer etc. The Guiding Opinions on the Supplementary Insurance of Major Diseases for Urban and Rural Residents collectively issued by six ministries should be implemented. Supplementary Insurance should be well connected with NRCMS policy on the benefits for major diseases and should cover the mentioned 20 major diseases as preference.
Fourth, NRCMS payment reforms should be accelerated, in terms of using pre-payment of total medical cost, disease-based payment, service unit-based payment and capitation to replace fee-for-service. The reforms aim to control medical costs, modify health service behaviors and enhance fund performance.
Fifth, the engagement of entrusted qualified commercial insurance agencies in the operation of NRCMS should be accelerated; so as to establish an operational mechanism that to some degree separates the management, operation and supervision of NRCMS.
Sixth, the experience of the last decade should be diligently studied to facilitate the formulation of the Regulations on Administration of New Rural Cooperative Medical Scheme. The administration of NRCMS should be legislated as soon as possible.
It has been proven that NRCMS, a suitable mechanism for rural China, is an important crystallization of basic medical insurance system for rural residents in current circumstances. In the last decade, NRCMS has grown up from a new born baby and is now playing a vital role for the health of the rural residents. As the competent authority of NRCMS, the Ministry of Health will collaborate with other related ministries to continue to promote its development and steadily improve rural residents’ health status.